Comparison of Acute Kidney Injury After Robot-Assisted Laparoscopic Radical Prostatectomy Versus Retropubic Radical Prostatectomy: A Propensity Score Matching Analysis

Eun-Young Joo, Yeon-Jin Moon, Syn-Hae Yoon, Ji-Hyun Chin, Jai-Hyun Hwang, Young-Kug Kim, Eun-Young Joo, Yeon-Jin Moon, Syn-Hae Yoon, Ji-Hyun Chin, Jai-Hyun Hwang, Young-Kug Kim

Abstract

Acute kidney injury (AKI) is associated with extended hospital stay, a high risk of progressive chronic kidney diseases, and increased mortality. Patients undergoing radical prostatectomy are at increased risk of AKI because of intraoperative bleeding, obstructive uropathy, older age, and preexisting chronic kidney disease. In particular, robot-assisted laparoscopic radical prostatectomy (RALP), which is in increasing demand as an alternative surgical option for retropubic radical prostatectomy (RRP), is associated with postoperative renal dysfunction because pneumoperitoneum during RALP can decrease cardiac output and renal perfusion. The objective of this study was to compare the incidence of postoperative AKI between RRP and RALP.We included 1340 patients who underwent RRP (n = 370) or RALP (n = 970) between 2013 and 2014. Demographics, cancer-related data, and perioperative laboratory data were evaluated. Postoperative AKI was determined according to the Kidney Disease: Improving Global Outcomes criteria. Operation and anesthesia time, estimated blood loss, amounts of administered fluids and transfused packed red blood cells, and the lengths of the postoperative intensive care unit and hospital stays were evaluated. Propensity score matching analysis was performed to reduce the influence of possible confounding variables and adjust for intergroup differences between the RRP and RALP groups.After performing 1:1 propensity score matching, the RRP and RALP groups included 307 patients, respectively. The operation time and anesthesia time in RALP were significantly longer than in the RRP group (both P < 0.001). However, the estimated blood loss and amount of administered fluids in RALP were significantly lower than in RRP (both P < 0.001). Also, RALP demonstrated a significantly lower incidence of transfusion and smaller amount of transfused packed red blood cells than RRP (both P < 0.001). Importantly, the incidence of AKI in RALP was significantly lower than in RRP (5.5% vs 10.4%; P = 0.044). Furthermore, the length of hospital stay in RALP was also significantly shorter (P < 0.001).The incidence of AKI after RALP is significantly lower than after RRP. RALP can therefore be a better surgical option than RRP in terms of decreasing the frequency of postoperative AKI.

Conflict of interest statement

The authors have no funding and conflicts of interest to disclose.

Figures

FIGURE 1
FIGURE 1
Study flow diagram. RALP = robot-assisted laparoscopic radical prostatectomy, RRP = retropubic radical prostatectomy.
FIGURE 2
FIGURE 2
Incidences of postoperative AKI between the RRP and RALP groups. The incidence of AKI after RALP was significantly lower than after RRP. AKI =  acute kidney injury, RALP =  robot-assisted laparoscopic radical prostatectomy, RRP = retropubic radical prostatectomy.

References

    1. Heidenreich A, Bellmunt J, Bolla M, et al. EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and treatment of clinically localised disease. Eur Urol 2011; 59:61–71.
    1. Millin T. Retropubic prostatectomy; a new extravesical technique; report of 20 cases. Lancet 1945; 2:693–696.
    1. Walsh PC. Anatomic radical prostatectomy: evolution of the surgical technique. J Urol 1998; 160:2418–2424.
    1. Steiner MS. Continence-preserving anatomic radical retropubic prostatectomy. Urology 2000; 55:427–435.
    1. Montorsi F, Salonia A, Suardi N, et al. Improving the preservation of the urethral sphincter and neurovascular bundles during open radical retropubic prostatectomy. Eur Urol 2005; 48:938–945.
    1. Graefen M, Walz J, Huland H. Open retropubic nerve-sparing radical prostatectomy. Eur Urol 2006; 49:38–48.
    1. Guillonneau B, Cathelineau X, Barret E, et al. Laparoscopic radical prostatectomy: technical and early oncological assessment of 40 operations. Eur Urol 1999; 36:14–20.
    1. Jacobsen NE, Moore KN, Estey E, et al. Open versus laparoscopic radical prostatectomy: a prospective comparison of postoperative urinary incontinence rates. J Urol 2007; 177:615–619.
    1. Rassweiler J, Schulze M, Teber D, et al. Laparoscopic radical prostatectomy with the Heilbronn technique: oncological results in the first 500 patients. J Urol 2005; 173:761–764.
    1. Novara G, Ficarra V, Rosen RC, et al. Systematic review and meta-analysis of perioperative outcomes and complications after robot-assisted radical prostatectomy. Eur Urol 2012; 62:431–452.
    1. Callery MP, Soper NJ. Physiology of the pneumoperitoneum. Baillieres Clin Gastroenterol 1993; 7:757–777.
    1. Gainsburg DM. Anesthetic concerns for robotic-assisted laparoscopic radical prostatectomy. Minerva Anestesiol 2012; 78:596–604.
    1. Bishara B, Karram T, Khatib S, et al. Impact of pneumoperitoneum on renal perfusion and excretory function: beneficial effects of nitroglycerine. Surg Endosc 2009; 23:568–576.
    1. McDougall EM, Monk TG, Wolf JS, Jr, et al. The effect of prolonged pneumoperitoneum on renal function in an animal model. J Am Coll Surg 1996; 182:317–328.
    1. Sassa N, Hattori R, Yamamoto T, et al. Direct visualization of renal hemodynamics affected by carbon dioxide-induced pneumoperitoneum. Urology 2009; 73:311–315.
    1. Chertow GM, Burdick E, Honour M, et al. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol 2005; 16:3365–3370.
    1. Hobson C, Ozrazgat-Baslanti T, Kuxhausen A, et al. Cost and mortality associated with postoperative acute kidney injury. Ann Surg 2015; 261:1207–1214.
    1. Kim SC, Song C, Kim W, et al. Factors determining functional outcomes after radical prostatectomy: robot-assisted versus retropubic. Eur Urol 2011; 60:413–419.
    1. Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Modification of Diet in Renal Disease Study Group. Ann Intern Med 1999; 130:461–470.
    1. Lenoir B, Merckx P, Paugam-Burtz C, et al. Individual probability of allogeneic erythrocyte transfusion in elective spine surgery: the predictive model of transfusion in spine surgery. Anesthesiology 2009; 110:1050–1060.
    1. Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1). Crit Care 2013; 17:204.
    1. Costalonga EC, Costa ESVT, Caires R, et al. Prostatic surgery associated acute kidney injury. World J Nephrol 2014; 3:198–209.
    1. Youssef MA, saleh Al-Mulhim A. Effects of different anesthetic techniques on antidiuretic hormone secretion during laparoscopic cholecystectomy. Surg Endosc 2007; 21:1543–1548.
    1. Myre K, Rostrup M, Eriksen M, et al. Increased spillover of norepinephrine to the portal vein during CO-pneumoperitoneum in pigs. Acta Anaesthesiol Scand 2004; 48:443–450.
    1. Modi PK, Kwon YS, Patel N, et al. Safety of robot-assisted radical prostatectomy with Pneumoperitoneum of 20 mm Hg: a study of 751 patients. J Endourol 2015; 29:1148–1151.
    1. Ahn JH, Lim CH, Chung HI, et al. Postoperative renal function in patients is unaltered after robotic-assisted radical prostatectomy. Korean J Anesthesiol 2011; 60:192–197.
    1. De Carlo F, Celestino F, Verri C, et al. Retropubic, laparoscopic, and robot-assisted radical prostatectomy: surgical, oncological, and functional outcomes: a systematic review. Urol Int 2014; 93:373–383.
    1. Karkouti K, Wijeysundera DN, Yau TM, et al. Acute kidney injury after cardiac surgery: focus on modifiable risk factors. Circulation 2009; 119:495–502.
    1. Karkouti K, Beattie WS, Wijeysundera DN, et al. Hemodilution during cardiopulmonary bypass is an independent risk factor for acute renal failure in adult cardiac surgery. J Thorac Cardiovasc Surg 2005; 129:391–400.
    1. Habib RH, Zacharias A, Schwann TA, et al. Role of hemodilutional anemia and transfusion during cardiopulmonary bypass in renal injury after coronary revascularization: implications on operative outcome. Crit Care Med 2005; 33:1749–1756.
    1. Ranucci M, Romitti F, Isgro G, et al. Oxygen delivery during cardiopulmonary bypass and acute renal failure after coronary operations. Ann Thorac Surg 2005; 80:2213–2220.
    1. Johannes T, Mik EG, Nohe B, et al. Acute decrease in renal microvascular PO2 during acute normovolemic hemodilution. Am J Physiol Renal Physiol 2007; 292:F796–F803.
    1. Haase M, Bellomo R, Haase-Fielitz A. Novel biomarkers, oxidative stress, and the role of labile iron toxicity in cardiopulmonary bypass-associated acute kidney injury. J Am Coll Cardiol 2010; 55:2024–2033.
    1. Hod EA, Zhang N, Sokol SA, et al. Transfusion of red blood cells after prolonged storage produces harmful effects that are mediated by iron and inflammation. Blood 2010; 115:4284–4292.
    1. Ozment CP, Turi JL. Iron overload following red blood cell transfusion and its impact on disease severity. Biochim Biophys Acta 2009; 1790:694–701.
    1. Tan TW, Farber A, Hamburg NM, et al. Blood transfusion for lower extremity bypass is associated with increased wound infection and graft thrombosis. J Am Coll Surg 2013; 216:1005–1014.
    1. Romano G, Mastroianni C, Bancone C, et al. Leukoreduction program for red blood cell transfusions in coronary surgery: association with reduced acute kidney injury and in-hospital mortality. J Thorac Cardiovasc Surg 2010; 140:188–195.
    1. Weinberg JA, McGwin G, Jr, Marques MB, et al. Transfusions in the less severely injured: does age of transfused blood affect outcomes? J Trauma 2008; 65:794–798.
    1. Wen T, Deibert CM, Siringo FS, et al. Positioning-related complications of minimally invasive radical prostatectomies. J Endourol 2014; 28:660–667.
    1. Novara G, Ficarra V, D’Elia C, et al. Prospective evaluation with standardised criteria for postoperative complications after robotic-assisted laparoscopic radical prostatectomy. Eur Urol 2010; 57:363–370.
    1. Agarwal PK, Sammon J, Bhandari A, et al. Safety profile of robot-assisted radical prostatectomy: a standardized report of complications in 3317 patients. Eur Urol 2011; 59:684–698.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera